Buried deep within Obamacare is a provision that takes away health care from you and your doctors, by taking away payment for critical health care that may be needed to save your life. It is called The Independent Payment Advisory Board (IPAB).
The board will be independent of you, your doctors, your hospitals, Medicare, Congress, the judiciary, the democratic process, ultimately even the Constitution itself. As the Cato Institute tried to warn us five years ago, IPAB is “independent in the worst sense of the word: independent of Congress, independent of the president, independent of the judiciary, and independent of the will of the people.”
IPAB is to be composed of 15 unelected bureaucrats appointed by the president and confirmed by the Senate. But the board and its powers are so dangerous that even President Obama never made any appointments.
Starting next year, if Medicare spending is projected to grow faster than the rate of economic growth per capita plus 1 percentage point, IPAB is empowered to make a proposal that will cut Medicare spending at least to the targeted growth rate. IPAB will be proposing such Medicare cuts every year starting next year because historically, Medicare spending has grown every year by per capita economic growth plus 2.6 percentage points.
Obamacare, however, expressly excluded IPAB from achieving the required savings by rationing health care, raising taxes, increasing cost-sharing in Medicare, cutting Medicare benefits, or altering Medicare eligibility. That leaves IPAB with just 2 options — slash payments to doctors, hospitals and other health care providers under Medicare, or deny specific health care treatments to seniors on grounds they are not “cost effective,” as the British National Health Service does for socialized medicine, so admired by Democrats.
Both of which add up to rationing after all. Overall, Obamacare cut more than $700 billion from Medicare, almost all coming out of payments to doctors and hospitals for health care for seniors. But if doctors and hospitals are not going to be paid their fees, seniors will not be getting the health care they expect under Medicare.
The chief actuary for Medicare reports that ultimately under Obamacare, Medicare payment rates will be only one third of what will be paid by private insurance and only half of what is paid by Medicaid, in which the poor often can’t find access to essential care. The actuaries explain that the Obamacare Medicare cuts would result in “negative total facility margins” for about 40 percent of hospitals, skilled nursing facilities, and home health agencies by 2050.
The actuaries add, “In practice, providers could not sustain continuing negative [losses] and, absent legislative changes, would have to withdraw from providing services to Medicare beneficiaries.” Timothy Jost writes in the New England Journal of Medicine, “If the gap between private and Medicare rates continues to grow, health care providers may well abandon Medicare.”
Under Obamacare, when IPAB proposes these Medicare cuts, they automatically become law, unless Congress passes and the president signs alternative cuts of the same amount. Obamacare requires the secretary of health and human services to implement the IPAB cuts otherwise.
Moreover, Obamacare empowers the board to propose these Medicare cuts even with just one member of the board appointed. If no one is ever appointed, Obamacare requires the secretary of health and human services to make the required Medicare cuts every year.
But Obamacare does not limit IPAB to cutting Medicare. Obamacare authorizes IPAB to make cuts “to slow the growth in national health expenditures” and “Non-Federal Health Care Programs.” Indeed, with IPAB’s Medicare cuts, those broader cuts to national health care spending and doctors and hospitals will be necessary “to maintaining or enhancing beneficiary access to quality care under [Medicare].”
Obamacare further provides that nothing that the board does can be challenged or reviewed in any court, federal or state. Obamacare even purports to restrict Congress’ power to repeal IPAB.
Obamacare specifically states that Congress can only repeal IPAB through a precisely worded joint resolution introduced in both houses of Congress in January 2017, which Republicans have already introduced. Obamacare further provides that repeal can only be enacted by a three-fifths supermajority in both houses, by Aug. 15. Otherwise, Obamacare states Congress may never, ever repeal IPAB afterward.
IPAB reflects a Hugo Chavez-style socialist dictatorship that threatens the very lives of the American people, by denying them health care when they most need it. We must get rid of it now, before it is too late.
• Peter J. Ferrara is a senior fellow at the Heartland Institute, and served in the Reagan and George H.W. Bush administrations.
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